Neulasta and V15.9

We use V15.9 when a patient has received Neulasta after their chemo treatment and the chemo is not on the claim (e.g. chemo in June 30, Neulast in July and that's the only month's service - we bill monthly outpaitent hosp based clinic). However, we've experienced where a coder will not add the v15.9 without documentation on the order (order says ca dx only) to support it. My question is what type of verbiage needs to be in the notes in order to add Neulasta? This is a general coder and oncology is not their speciality. HELP

In order for Neulasta to get paid and chemo administration is not on the claim, we would add the V15.9 along with the cancer code (per the LCD). We've experienced denials if just the cancer code is used by itself.

My question is what verbiage should be in the medical record to alert the coder to add
V15.9 when Neulasta is the only drug on the claim.

You might want to review your LCDs. According to ours, the indications for Neulasta (given for CIN) require the use of V58.11/V58.12 as a primary and 288.03 as a secondary dx. It appears that some of our carriers would not pay without seeing a ca dx (in the third place) on the claims. Best regards!

I code for oncology and we always bill V66.2 (convalescence care following chemo) and then the cancer diagnosis. We always get paid.

So if a patient has chemo on Monday then 24 hours late has a Neulast injection on Tuesday, you code V66.2? We bill on a monthly basis so if the patient has chemo on June 30 then Neulasta on July 1 and that's the only service for that month, we bill the cancer code and V15.9 and it is covered but if we don't include V15.9, it's a denial provided it's the only service on the claim. I didn't think V66.2 was appropriate if they were continuing to get chemo.

Its pallative care following chemo, not necessarily meaning they are no longer receiving chemo at all, but meaning they need additional care because they are on chemo. Seeing how Nuelasta is not given on the same day as chemo, it falls into that category of convalescence/pallative care. Hope that makes sense.

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